St. Alexius Stroke Center
1) About St. Alexius Medical Center ................................................ 1
a) Map – How to Find Us
2) Impact of Stroke ............................................................... 3
3) Introduction .................................................................. 4
4) Part One: Understanding Stroke ................................................. 5
a) What is Stroke?
b) Warning Signs of Stroke
d) Stroke is an Emergency
e) Risk Factors for Stroke
f ) Stroke Prevention
5) Part Two: Diagnosis and Treatment of Stroke ..................................... 14
a) Diagnosing Stroke and Stroke Risk
b) Stroke Treatment
c) Surgical Treatment Options
d) Interventional Radiology Treatment Options
6) Part Three: Patient Care at the St. Alexius Stroke Center ........................... 18
a) The St. Alexius Hospitalist Program
b) The St. Alexius Critical Care Program
7) Part Four: Going Home from the Hospital ....................................... 21
a) Discharge Planning
c) Follow-up Appointments
d) Blood Sugar and Blood Pressure Checks
e) Seek Help Immediately If
8) Part Five: Rehabilitation Following Stroke ....................................... 24
a) Rehabilitation Services at St. Alexius
b) Stroke Disabilities
c) Life After Stroke: Survivor and Caregiver
The following organizations were used as resources to create this patient guidebook. Copyright of the
information is retained by the original organization. These organizations do not endorse St. Alexius
Medical Center. For more information, please contact St. Alexius Medical Center, or one of these associations.
National Stroke Association
9707 E. Easter Lane
Centennial, CO 80112
phone: (800) 787-6537
American Heart Association
1005 12 Ave SE
Jamestown, ND 58401
phone: (800) 437-9710
American Stroke Association
1005 12 Ave SE
Jamestown, ND 58401
phone: (800) 437-9710
About St. Alexius
St. Alexius Medical Center is a 306-bed, full-service, acute
care medical center offering a full line of inpatient and
outpatient medical services, including primary and
specialty physician clinics; home health and hospice
services; durable medical equipment services and a fitness
and human performance center.
Since our founding in 1885, St. Alexius Medical Center
has been dedicated to serving the residents of central
and western North Dakota, northern South Dakota and
Besides the main campus located in Bismarck, North Dakota, St. Alexius owns and operates hospitals
and clinics in Garrison, ND and Turtle Lake, ND and manages the hospital and clinics owned by
Mobridge Regional Hospital in Mobridge, SD. St. Alexius also owns and operates a primary care clinic
in Mandan, ND and specialty and primary care clinics in Minot, ND.
St. Alexius Medical Center is a Roman Catholic organization whose sponsors are the Sisters of
St. Benedict of the Annunciation Monastery, Bismarck, ND and as an organization we follow the
Ethical and Religious Directives for Catholic Health Care Services as promulgated by the United
States Conference of Catholic Bishops.
“Let All Be Received As Christ.”
Map to St. Alexius
Impact of Stroke
• About 780,000 Americans each year suffer a new or recurrent stroke. That mans, on average, a
stroke occurs every 40 seconds.
• Stroke kills more than 150,000 people each year. That’s about 1 of every 16 deaths. It’s the No. 3
cause of death behind diseases of the heart and cancer.
• On average, every 3 to 4 minutes someone dies of stroke.
• Of every 5 deaths from stroke, 2 occur in men and 3 in women.
• Americans will pay about $65.5 billion in 2008 for stroke-related medical costs and disability.
• Stroke is the leading cause of longterm disability in the US and the No.1 reason for admission to
longterm care facilities.
The St. Alexius Stroke Center
The St. Alexius Stroke Center – one of the first
centers of its kind in North Dakota – is
pioneering new approaches to the diagnosis
and treatment of stroke that can significantly
improve patient chances for an optimal recovery.
New drugs, advanced surgical techniques and
innovative interventional procedures are among
the effective new medical options now available
for stroke patients.
The Center, founded in 1999, brings together
the expertise of specialists in many difference
areas to provide our patients with the benefit
of a collaborative team approach. The team
includes neurologists, neurosurgeons, interventional
radiologists, emergency medicine,
rehabilitation specialists, hospitalists and
intensivists, physical, occupational, and speech
therapists, and a dedicated nursing staff.
Our goals as a Stroke Center include improving
stroke care and ensuring that our stroke patients
receive optimal stroke treatment.
We have prepared this guidebook to provide you
with some important information about stroke.
The Guidebook explains the different types of
stroke, describes the warning signs and risk
factors for stroke, and recommends steps you can
take to reduce your risk for stroke. You will also
learn about advanced techniques for diagnosis
and treatment of stroke available at St. Alexius
Medical Center and information that will
prepare you for discharge and your recovery.
We want you to be familiar with the warning
signs and risk factors for stroke, and then take
the appropriate steps to change the risk factors
within your control so you can prevent another
stroke. Most importantly, if you or someone you
know should experience symptoms of stroke,
seek emergency help immediately – call 9-1-1 –
do not wait.
If you have any questions after reading this
guidebook, please feel free to call us at the
St. Alexius Stroke Center: (701) 530-6640.
Dr. S. Shiraz Hyder,
Director of the St. Alexius
Stroke Center, leads
a team of dedicated,
What is a Stroke
A stroke or “brain attack” occurs when a blood
clot blocks an artery (a blood vessel that carries
blood from the heart to the body) or a blood
vessel (a tube through which the blood moves
through the body) breaks, interrupting blood
flow to an area of the brain. When blood fails
to get through to the affected parts of the brain,
the oxygen supply is cut off, and brain cells begin
to die. When brain cells die during a stroke,
abilities controlled by that area of the brain are
lost. These abilities include speech, movement
and memory. How a stroke patient is affected
depends on where the stroke occurs in the brain
and how much of the brain is damaged.
Strokes fall into several major categories, based
on whether the disrupted blood supply is caused
by a blocked blood vessel (also known as an
ischemic stroke) or a burst blood vessel (also
know as a hemorrhagic stroke). Since each type
of stroke has a different type of treatment, it is
very important for the physician to determine
the cause of the stroke, as well as the location, as
quickly as possible.
Ischemic stroke occurs when arteries are blocked
by blood clots or by the gradual buildup of
plaque and other fatty deposits. Almost 85
percent of all strokes are ischemic. These fatty
deposits lining the vessel walls, also know as
atherosclerosis, can result in two types of
Thrombotic Stroke is the most common
type of stroke. In this type of stroke, blood
flow is impaired because of a blockage to
one or more of the arteries supplying blood
to the brain. The process leading to this
blockage is known as thrombosis or blood
clot. Strokes caused in this way are called
thrombotic strokes. That’s because the
medical word for a clot that forms on a
blood vessel deposit is thrombus. Sometimes
the clot occurs in one of the neck (carotid
or vertebral) arteries that transport blood
from the heart to the brain. Blood clots
form most often in arteries damaged by
atherosclerosis, a disease in which rough,
fatty deposits build up on the walls of the
arteries and project into the bloodstream.
These deposits gradually narrow the
passageway, causing the blood flow to
slow down and, sometimes, to completely
occlude (block) the artery.
Embolic Stroke is also caused by a clot.
In an embolic stroke, a blood clot forms
somewhere in the body (usually the heart)
and travels through the blood stream to the
brain. Once in the brain, the clot travels
through the arteries. As the arteries branch
into smaller vessels, the clot reaches a point
where it can go no further and plugs the
vessel, cutting off the blood supply. The clot
lodges there, blocking the blood vessel and
causing a stroke. The medical word for this
type of blood clot is embolus.
The other main category of stroke, hemorrhagic
stroke, occurs when a blood vessel in or around
the brain breaks or bursts, spilling blood into the
brain or the area surrounding the brain. When
this occurs, the cells nourished by the artery
fail to get their normal supply of nutrients and
can’t function properly. Furthermore, blood
accumulates and compresses the surrounding
Hemorrhagic strokes are frequently caused by
two types of weakened blood vessels: aneurysms
and arteriovenous malformations (AVMs).
Aneurysms. An aneurysm is a ballooning
of a weakened region of a blood vessel. If left
untreated, the aneurysm continues to weaken
until it ruptures and bleeds into the brain.
Arteriovenous Malformations (AVMs).
An AVM is a cluster of abnormally formed
blood vessels. Any of these vessels can
rupture also causing bleeding in the brain.
Transient Ischemic Attacks (TIAs)
About one-third of all strokes are preceded by
one or more “mini-strokes,” known as transient
ischemic attacks (TIAs). TIAs can occur days,
weeks or even months before a stroke.
TIAs are caused by temporary interruptions in
the blood supply to the brain. The symptoms
occur rapidly and last a relatively short time,
usually from a few minutes to several hours,
always with complete recovery within 24 hours.
Because TIAs are temporary and the body soon
returns to normal, it is easy to ignore them or to
believe that the problem has disappeared. However,
it is dangerous to ignore TIAs, because
the underlying problem that caused the TIA
continues to exist. TIAs are often early warning
signs of more serious and debilitating stroke in
Common stroke symptoms include:
• Sudden numbness or weakness of the face,
arm or leg (especially on one side of the
• Sudden confusion, trouble speaking or
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden, severe headache with no known
Learn to Recognize Stroke Symptoms. Call
9-1-1 immediately if you have any of these
symptoms. Learning the signs of stroke can save
precious time and precious brain function.
Note the time you experienced your first
symptoms. This information is important to your
healthcare provider and can affect treatment
Diagnostic advances at the St. Alexius Stroke
Center have made it possible to diagnose these
important causes of stroke so treatment can be
arranged and offer patients the likelihood of a
Warning Signs of Stroke
Few Americans know the symptoms of stroke.
Learning them – and acting FAST when they
occur – could save your life or the life of a loved
Using the easy mnemonic device “FAST” to
remember stroke symptoms can help to
get rapid medical treatment for stroke. If
the stroke symptoms come on abruptly or
are one-sided, CALL 911 immediately for
• Uneven smile
• Facial droop / numbness
• Vision disturbance
A: ARM & LEG
• Difficulty walking
• Inappropriate words
• Time is critical
• CALL 911
Stroke is an Emergency
Call 9-1-1 if you see or have any of these
symptoms. Treatment can be more effective if
given early on. Every minute counts!
140/90 or above, it’s high. Talk to your doctor
about how to control it.
Special note: If symptoms appear for only a very
short period of time and then disappear, it could
mean a Transient Ischemic Attack or TIA. It’s
important to call 9-1-1 whenever you experience
any stroke symptom. While TIAs are not strokes,
they indicate serious underlying stroke risks and
are a powerful warning that a full stroke may
Getting emergency medical treatment is
important for several reasons: Only a doctor can
tell for sure if you are having a stroke or a TIA.
And, if you are having a stroke, emergency
medical treatment could save your life and
greatly improve your chances for successful
rehabilitation and recovery. If you are having a
TIA, your doctor will evaluate and treat the
underlying causes. Following your doctor’s
orders for medication and treatment can help
reduce your risk of having a stroke.
Risk Factors for Stroke
Knowing your risk for stroke is the first step in
preventing stroke. You can change or treat some
risk factors, but others you can’t.
Risk Factors for Stroke that can be
Changed, Treated or Controlled
• High Blood Pressure
This is the single most important risk factor
for stroke because it’s the No. 1 cause of stroke.
Know your blood pressure and have it checked
at least once every two years. If it’s consistently
• Tobacco Use
Don’t smoke cigarettes or use other forms of
tobacco. Tobacco use damages blood vessels.
The nicotine and carbon monoxide in cigarette
smoke damage the cardiovascular system in
many ways. The use of oral contraceptives
combined with cigarette smoking greatly
increases stroke risk.
• Diabetes Mellitus
Having diabetes increases your risk of stroke because
it can cause disease of blood vessels in the
brain. Many people with diabetes also have high
blood pressure, high blood cholesterol and are
overweight. Diabetes is treatable, but the presence
of the disease increases your risk of stroke.
Work with your doctor to manage diabetes and
reduce other risk factors.
• Carotid or Other Artery Disease
The carotid arteries in your neck supply most
of the blood to your brain. A carotid artery
damaged by a fatty buildup of plaque inside
the artery wall may become blocked by a blood
clot, causing a stroke.
Transient Ischemic Attacks (TIAs) are “mini
strokes” that produce stroke-like symptoms but
no lasting effects. Recognizing and treating
TIAs can reduce the risk of a major stroke.
Know the warning signs of a TIA and seek
emergency medical treatment immediately.
• Arterial Fibrillation or Other Heart Disease
This heart rhythm disorder raises the risk for
stroke. In atrial fibrillation, the heart’s upper
chambers quiver instead of beating, causing the
blood to pool and clot. If a clot breaks off, enters
the blood stream and lodges in an artery leading
to the brain, a stroke results. People with other
types of heart disease have a higher risk of
• Certain Blood Disorders
A high red blood cell count makes clots more
likely raising the risk of stroke. Sickle cell anemia
increases stroke risk because the “sickled” cells
stick to blood vessel walls and may block arteries.
• High Blood Cholesterol
High blood cholesterol increases the risk of
clogged arteries. If an artery leading to the brain
becomes blocked, a stroke can result.
• Physical Inactivity and Obesity
Inactivity, obesity or both can increase your risk
of high blood pressure, high blood cholesterol,
diabetes, heart disease and stroke.
Risk Factors for Stroke That Cannot be
• Increasing Age
Stroke affects people of all ages. But the older
you are, the greater your stroke risk. The chance
of having a stroke approximately doubles for
each decade of life after age 55.
In most age groups, more men than women have
stroke, but more women die from stroke. Use
of birth control pills and pregnancy increase a
woman’s risk of stroke.
• Heredity and Race
People whose close blood relatives have had
a stroke have a higher risk of stroke. African
Americans have a higher risk of death and
disability from stroke than whites, because they
have high blood pressure more often. Hispanic
Americans are also at higher risk of stroke.
• Prior Stroke
Someone who has had a stroke is at higher risk
of having another. A person who has had one
or more TIAs is almost 10 times more likely to
have a stroke than someone who is the same age,
sex and hasn’t had a stroke. Heart attack patients
are also at a higher risk of having a stroke.
• Excessive Alcohol Intake and Illegal Drug Use
Drinking an average of more than one drink per
day for women or more than two drinks a day
for men raises blood pressure. Drinking more
than two drinks per day may increase stroke
risk by 50%. Binge drinking can lead to stroke.
Abusing illegal drugs also carries a high risk of
Risk Factors That Can Be Changed
• Hypertension (high blood pressure)
• Heart disease
• High cholesterol level
• Excess alcohol intake
• Sedentary lifestyle
• Elevated hematocrit (increase in red blood cells) • Stress
• Use of oral contraceptives (especially for women who smoke)
Risk Factors That Cannot Be Changed
• Family or individual history of stroke or TIA
There are many positive steps that you can
take now to reduce your risk of stroke. Eighty
percent of strokes are preventable! The following
are the most important measures you can
take to control your stroke risk. These include
changing risk factors by medical treatment as
well as by positive lifestyle modifications.
Know Your Blood Pressure
High blood pressure (hypertension) is a leading
cause of stroke. Have your blood pressure
checked at least annually. If it is elevated, work
with your doctor to keep it under control. If
your doctor decides that you have high blood
pressure, she/he may recommend some changes
in your diet, regular exercise, or medicine.
Find Out if You Have Atrial
Your doctor can diagnose atrial fibrillation (AF)
by carefully taking your pulse. Atrial fibrillation
can be confirmed or ruled out with an electrocardiogram
(ECG), a recording of the electrical
activity of the heart, which can probably be
done in your doctor’s office. If you have AF, your
doctor may choose to lower your risk for stroke
by prescribing medicines called blood thinners.
Aspirin and warfarin (Coumadin) are the most
commonly prescribed treatments.
If You Smoke, Quit!
Smoking doubles the risk for stroke. However,
your risk begins to decrease the day you quit.
If You Drink Alcohol, do so in
If you drink, we recommend no more than two
drinks each day, and if you don’t drink, don’t
start. Remember that alcohol is a drug and it
can interact with some drugs. Please ask your
doctor or pharmacist if any of the medicines you
are taking could interact with alcohol.
Know Your Cholesterol Numbers
If your total cholesterol level (LDL and HDL)
is over 200, talk to your doctor. You may be at
increased risk for stroke. LDL, known as the
“bad” cholesterol, is the form that builds up and
causes plaque which may narrow arteries and
limit or stop blood flow. LDL can be inherited
from your family members or be a result of your
body chemistry. It can also be the result of a diet
high in saturated fats, lack of exercise, or diabetes.
HDL is the “good” cholesterol that sweeps
the blood and removes plaque. Lowering your
cholesterol (if elevated) may reduce your risk
for stroke. High cholesterol can be controlled
in many individuals with diet and exercise, but
some individuals may require medications.
Include exercise in your daily routine. A brisk
walk for as little as 30 minutes a day can improve
your health in many ways, and may reduce your
risk for stroke. If you don’t enjoy walking, choose
another exercise or activity that you do enjoy,
such as biking, swimming, gold, tennis, dance
or aerobics. Make time each day to take care of
yourself by exercising.
Follow your doctor’s advice carefully to control
your diabetes. Often, diabetes can be controlled
through careful attention to what you eat. Work
with your doctor and a dietitian (a health care
professional who helps promote good health
through proper eating) to develop a healthy
eating program that fits your lifestyle. Your
doctor can prescribe lifestyle changes and
medication that can help control your diabetes.
Having diabetes puts you at an increased risk
for stroke; by controlling your diabetes, you may
lower your risk for stroke.
Maintain a Healthy Weight
Being overweight strains the heart and blood
vessels and is associated with high blood
pressure. Obesity also predisposes a person
to heart disease and diabetes, both of which
increase the risk for stroke. Keeping your weight
to recommended levels for your height and build
is a prudent preventive measure.
Enjoy a Lower Sodium (Salt),
Lower Fat Diet
By cutting down on sodium and fat in your diet,
you may be able to lower your blood pressure,
and, most importantly, lower your risk for stroke.
Work towards a balanced diet each day with
plenty of fruits, vegetables, grains, and a moderate
amount of protein (meat, fish, eggs, milk, nuts,
tofu, and some beans). Adding fiber, such as
whole grain bread and cereal products, raw,
unpeeled fruits and vegetables and dried beans,
to the diet can reduce cholesterol levels by 6 to
Circulation Problems (movement of the
blood through the heart and blood vessels)
Ask your doctor if you have circulation problems
which increase your risk for stroke. Your doctor
can check to see if you have problems in the
circulation supplying blood to your brain. Fatty
deposits can block the arteries which carry
blood from your heart to your brain. These
arteries, located on each side of your neck, are
called carotid and vertebral arteries. This kind
of blockage, if left untreated, can cause stroke.
Circulation problems can usually be treated with
medications. Occasionally, surgery is necessary
to correct circulation problems such as a blocked
Regular Medical Check-ups
Risk factors such as heart disease, high blood
pressure, and elevated blood cholesterol must be
monitored by your physician on a regular basis.
These risk factors can be changed or, at minimum,
controlled by proper medical treatment and
appropriate diet and lifestyle modifications.
Because stress may increase blood pressure, it
is linked indirectly to stroke risk. A one-time
stressful event rarely causes a stroke, but longterm
unresolved stress can contribute to high
blood pressure. Stress management, including
relaxation techniques, biofeedback, exercise and
counseling, appear to be useful in the treatment
of high blood pressure, thus lowering the risk of
If you have any stroke symptoms, seek immediate
medical attention. These include:
• Sudden numbness or weakness of the face,
arm or leg (especially on one side of the
• Sudden confusion, trouble speaking or
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of
balance or coordination
• Sudden, severe headache with no known
If you have experienced any of these symptoms,
you may have had a TIA or mini-stroke. Ask
your doctor if you can lower your risk for stroke
by taking aspirin, or by other means. If you think
someone may be having a stroke, act FAST.
Diagnosis and Treatment of Stroke
If you have shown symptoms of stoke or a TIA,
your doctor will gather information to make a
diagnosis. He or she will:
• Review your medical history
• Do a physical and neurological examination
• Have blood tests done
• Get a CT scan of the brain
• Order additional diagnostic testing,
The St. Alexius Stroke Center has state-of-theart
brain diagnostic devices available to obtain
in-depth information about a patient’s status.
These highly sensitive tools are of critical
importance in diagnosing abnormalities that
place a patient at high risk for stroke, such as
a blocked blood vessel or the presence of an
aneurysm or AVM.
To obtain complete diagnostic information, it is
likely that several (but not all) of the following
diagnostic studies will be performed during an
evaluation for stroke or stroke risk.
Computerized Tomography (CT) Scan
is generally the first diagnostic test done for a
patient who is suspected of having a stroke. A
CT scan involves the use of low-dose x-rays to
visualize the brain. CT test results provide
information about the cause of stroke, location
and extent of brain injury.
Magnetic Resonance Imaging (MRI) uses a
large magnetic field to produce an image of the
brain. The MRI scan produces a sharper, more
precise image than CT scans and are used to
locate the exact area of the stroke. The precision
of an MRI is also helpful when small blood
vessels are affected.
Magnetic Resonance Angiography (MRA)
is a noninvasive study that gathers information
about how blood is flowing in the patient’s brain.
Carotid Ultrasound is a noninvasive study
used to diagnose blockage in the carotid arteries.
The study uses sound waves to track the speed
of blood flow through the carotid arteries and if
there is narrowing or blockage.
Transcranial Doppler (TCD) is a noninvasive
study that uses ultrasound (sound waves) to
check the blood flow through the blood in the
brain via a small probe placed against the skull.
TCD is one method used to monitor the
progress of a patient’s medical treatment.
PET Scanning, a highly specialized brain
image, measures brain cell metabolism to
determine if brain tissue is functioning even if
blood flow to that area appears to be diminished.
CT scans help distinguish the type of stroke.
Cerebral Angiography (angiogram) is a
diagnostic study that requires injection of a
contrast dye through a major blood vessel
(usually the femoral artery in the thigh) for
evaluation of blood flow to the brain.
Echocardiogram – also called an echo, uses
ultrasound waves to show a moving picture of
the size and shape of the heart, the valves, and
how the heart moves as it beats.
Much of the damage caused by a stroke
occurs in the first six hours. Most strokes
can be treated.
Acute Treatment - Thromboyltics
The thrombolytic drug tPA (tissue plasminogen
activator), is the first FDA-approved acute
stroke treatment. This drug helps reestablish
blood flow to the brain by dissolving the clots
which are blocking the blood flow. To be
effective, thrombolytic therapy should be given
as quickly as possible. If given within the first
few hours after stroke onset, this drug may
dramatically minimize stroke damage.
Medications to Treat Stroke
A number of medications that help prevent
stroke in high-risk patients, particularly those
who have had a previous TIA or minor stroke.
These drugs fall into two major categories:
anticoagulants (such as warfarin [Coumadin]
or ximelgatran) and antiplatelet agents (such
as aspirin, dipyridamole [Aggrenox] and
Antiplatelet medicine keeps blood clots
from forming by preventing blood platelets
from sticking together. Antiplatelet drugs
include aspirin, clopidogrel (Plavix) and
Surgical Treatment Options
Surgery is an accepted way of preventing stroke
for patients with certain conditions.
Carotid endarterectomy is a procedure in which
blood vessel blockage is surgically removed from
the carotid artery. It has recently been proven
that for certain patients with minor strokes or
TIAs, carotid endarterectomy is highly beneficial
in preventing future strokes.
Angioplasty and Stenting of Vessels in the
Neck and Brain
Doctors sometimes use balloon angioplasty and
implantable steel screens called stents in the
vessels of the neck and brain to open partially
blocked blood vessels.
Anticoagulants or “blood thinners” are
medicine that delay the clotting of blood.
Two examples are heparin and warfarin
(Coumadin). They are also used for treatment
and prevention of blood clots in the
other blood vessels such as the leg or lungs.
In addition to new medications and surgical
techniques, The St. Alexius Stroke Center is
performing new interventional radiology
procedures to prevent stroke in patients.
Mechanical devices are available to physically
remove blood clots that are blocking blood
vessels within the brain. One of the devices,
the MERCI Retrieval System, was recently
approved by the FDA. The device works like a
corkscrew to pull a clot out of bleed vessels. For
selected patients, devices such as the MERCI
retriever can effectively treat stroke even up to
8 hours after symptom onset.
A small catheter (tube) is threaded into the
brain during specialized brain imaging and clot
dissolving medications are delivered directly into
the blocked blood vessel.
Dr. Herbal, interventional radiologist, performs
specialized procedures for acute stroke
Patient Care at the St. Alexius Stroke Center
In addition to the diagnostic and therapeutic
services offered by the St. Alexius Stroke
Center, a full spectrum of allied patient care
services is available. To ensure that emergency
care is administered as quickly as possible to
stroke victims, the Emergency Department staff
provide an early and essential communications
link in the identification and treatment of stroke
After care in the Emergency Room or the
Intensive Care Unit (ICU), stroke patients
are generally admitted to the Inpatient Stroke
Unit for continued observation, treatment and
eventual rehabilitation. During their hospital
stay, patients will receive care from a dedicated,
The team includes:
• Physicians - including the patient’s primary
care physician and/or hospitalist, as well as
physicians on the neurology, neurosurgery,
critical care, interventional radiology and
• Nurses - assess and coordinate patient needs,
administer treatment, provide patient/family
• Nursing Assistants - provide personal care
• Physical, Occupational and Speech Therapists -
provide individualized rehabilitation treatment
• Social Worker - offers support to patient and
family, works to coordinate any appropriate
• Pastoral Care - offers spiritual support to
patient and family
• Case Management - oversees hospitalization
and coordinates with insurance payors, works
to insure follow-up arrangements such as
• Dietitian - assists with proper design of
nutritional and caloric intake
Dedicated staff offer patient care on the
The St. Alexius Hospitalist Program
During your stay at St. Alexius Medical Center,
you will be treated by many healthcare professionals.
Among them will be a group of doctors
known as hospitalists. A hospitalist is a medical
doctor who specializes in treating adult patients
in the hospital. The hospitalists work with
other healthcare professionals, including your
neurologist, to coordinate all aspects of your
treatment while you are a patient. The
hospitalists will communicate with your
regular doctor to arrange for care with your
doctor after you go home.
part of the
The hospitalists are in the hospital around the
clock and are available to meet your medical
needs during your stay and to meet with you
and your family to discuss your treatment. If you
or a family member would like to speak with
your hospitalist, please notify your nurse so your
hospitalist can be paged.
The St. Alexius Critical Care
The intensive/critical care unit at St. Alexius,
under the direction of 24-hour intensivists
(physicians specialized in the care of critically
ill patients), focuses on the care of critically ill
stroke patients who may need to be treated in
the intensive care unit. Patients who receive
thrombolytic therapy or who undergo interventional
procedures are often monitored for
12-24 hours in the intensive care unit. Patients
with more severs strokes may also be monitored
in the intensive care unit in order to more
closely monitor their neurologic, respiratory, or
Stroke patients needing Intensive Care treatment
are cared for by one of the St. Alexius
Going Home from the Hospital
The multidisciplinary planning team will involve
you and your family in planning for discharge.
If You are Going Home
Since you may not be permitted to drive following
your stroke, you will need to make arrangements
for someone to drive you home. You will receive
written discharge instructions concerning medication,
physical therapy, activity, etc. Additional
home equipment may be recommended and staff
will assist you with obtaining it.
If You are Going to a Swing Bed,
Rehab, or Skilled Nursing Facility
The decision to go home or to a swing bed,
rehab, or skilled nursing facility will be made
collectively by you and your family, the discharge
planning team, your physician, and your physical
You will be provided with a list of medications
you are to be taking at the time of discharge.
Your nurse and/or physician will review your
medications with you prior to discharge and
provide you with prescriptions for any new
medications you are being discharged on. Keep
a written list of the medicine you take, the
amounts, and when and why you take them. Do
not use any medicines, over-the-counter drugs,
vitamins, herbs, or food supplements without
first talking to caregivers.
Always take your medicine as directed by caregivers.
Call your caregiver if you think your
medicines are not helping or if you feel you are
having side effects. Do not quit taking your
medicines until you discuss it with your caregiver.
Aspirin to stop blood clots: Aspirin helps
thin the blood to keep blood clots from forming.
If your doctor tells you to take aspirin, do not
take acetaminophen or ibuprofen instead. Do
not take more or less aspirin than your doctor
says to take.
Blood thinners: Blood thinners are medicines
that help prevent clots from forming in the
blood. Clots can cause strokes, heart attacks, and
death. Blood thinners may cause you to bleed or
bruise more easily. Do the following if you are
taking a blood thinner:
• Watch for bleeding from your gums or nose,
or in your urine or stool.
• Use a soft washcloth on your skin and a soft
toothbrush to brush your teeth. Doing this
can keep your skin and gums from bleeding.
• Tell your dentist before dental cleanings, and
other providers before other procedures, that
you take blood thinning medicine.
• If you shave, use an electeric shaver.
• Do not play contact sports since you may
bleed or bruise easily.
• Wear a MedicAlert bracelet or necklace that
says you are taking a blood thinning medicine.
You may get one from your local drugstore
or contact the MedicAlert Foundation.
Your physicians will determine when and with
whom you need follow-up appointments. It is
important to keep these appointments so your
progress can be monitored. Please take a list
of your medications with you to your appointments.
Make a list of questions you might have
for your physician or provider before going to
the appointment so your questions can be
Blood Sugar and Blood
If you have diabetes, you will need to check
your blood sugar many times each day. Write
down your blood sugar level each time for your
provider to review. Your provider will tell you
what your blood sugar level should be.
If you have high blood pressure, you will need to
check and write down your blood pressure readings.
Caregivers will teach you or your family
how to check your blood pressure, and tell you
how often to do this. Keep track of your blood
pressure readings, along with the date and time
you took them. Take this record with you to
your doctor’s appointments.
Seek Care Immediately If:
• You have check pain that spreads to your
arms, jaw, or back.
• You have one or more of the following signs
or symptoms of a stroke:
• A very bad headache. This may feel
like the worst headache of your life.
• Confusion and problems speaking or
• Not able to see out of one or both of
• Too dizzy to stand, trouble walking,
or loss of balance
• Weakness or numbness of your face,
arm, or leg, especially on one side of
• You have trouble breathing.
This is an emergency – call 9-1-1. Ask for the
ambulance to take you to the nearest hospital.
Do not drive yourself.
Rehabilitation Following Stroke
Because of the tremendous advances in stroke
treatment, along with the ever-increasing
sophistication of rehabilitation techniques, the
outlook for stroke patients has never been more
Rehabilitation actually starts in the hospital as
soon as possible after the stroke. In patients who
are stable, rehabilitation may begin within two
days after the stroke has occurred, and should
be continues as necessary after release from
the hospital. Depending on the severity of the
stroke, rehabilitation options include a rehabilitation
unit in the hospital, home therapy, home
with outpatient therapy or a long-term care
facility that provides therapy and skilled nursing
The goal of rehabilitation is to improve function
so that the stroke survivor can become as
independent as possible. Successful stroke
rehabilitation is dependent on many factors,
including the severity of brain damage and
the cooperation of family and friends. Not
surprisingly, the attitude of the patient is a key
factor in speed and degree of recovery. A positive
outlook and high level of determination may
facilitate recovery. This must be accomplished in
a way that preserves dignity and motivates the
survivor to relearn basic skills that the stroke
may have taken away.
After a stroke, other blood vessels may be able
to take over for the damaged blood vessel. This
allows some cells to recover, although others
may still die. If the blood supply is cut off due to
a clot, the body works to dissolve the clot. This
means that the damaged part of the brain can
sometimes improve or return to normal without
rehabilitation. Most stroke patients, however,
will benefit from some type of rehabilitation.
Rehabilitation Services at
St. Alexius offers a wide variety of rehabilitation
services for stroke patients, ranging from
inpatient services on the Comprehensive
Inpatient Rehabilitation Unit, as well as several
types of outpatient therapies. During all phases
of rehabilitation and recovery, survivors will most
likely work with a team of professionals. Both
survivors and caregivers should get to know everyone
on the healthcare team and feel comfortable
addressing any recovery issues with them.
is an important
part of stroke
The recovery healthcare team can include:
• Physiatrists and Neurologists – who specialize
in physical medicine and rehabilitation and
determine the level of disability, monitor
health and treat any complications of stroke.
• Rehabilitation nurses – who assist patients to
make rehabilitation part of the daily routine
and help teach family members about strokerelated
disabilities, medication and other
• Psychologist, social workers and care managers –
who counsel patients with emotional and
readjustment issues and provide support,
information and community resources.
• Physical, occupational and recreation therapists
and speech-language pathologists – who work
directly with stroke survivors and their
caregivers to address needs in physical,
communication, thinking and swallowing
abilities and to reintroduce leisure and social
activities back into a survivor’s life.
You may also work with an ophthalmologist or
optometrist who will diagnose and treat specific
problems with blurred vision, partial or complete
loss of sight. Different types of vision therapies
are available to retrain, strengthen, or sharpen
vision following stroke.
Different areas of the brain control different
bodily functions. When certain brain cells are
not able to function due to stroke, the parts of
the body controlled by those cells are also unable
to function. For instance, if the left side of the
brain is damaged, most of the effects will occur
on the right side of the body. It’s also important
to note that most areas of the brain will continue
to function normally, despite substantial damage
in other areas.
Life After Stroke: Survivor and
Strokes can be life changing for stroke survivors
and their caregivers. After a stroke, both stroke
survivors and the family can be concerned about
being on their own at home. Among the common
concerns are the fears that:
• Fear of another stroke
• Difficulty accepting the changes in how their
bodies and minds work
• Apprehension about keeping survivors at
home or moving them to assisted living
• Overpowering responsibilities of round-theclock
• Fear of abandonment of friends and family
Some of the most common results of a stroke
are hemiparesis (paralysis on one side of the
body), aphasia (the loss of ability to speak or to
understand language), spatial-perceptual deficits,
learning difficulties, memory loss, behavioral/
emotional changes, and loss of motor skills.
If someone you know has suffered some of these
disabilities as a result of stroke, there are many
community resources available that can help you
cope with the situation and learn how to provide
the proper support and encouragement. The
St. Alexius Stroke Center can provide you with
an up-to-date list of community resources.
Some changes in behavior, such as memory loss,
can be so subtle they may not be noticed at first.
The stroke survivor may be anxious and cautious,
needing a reminder to finish a sentence or know
what to do next. Some stroke survivors have
difficulty with numbers and calculating. Family
members will need to learn to keep things in the
same place, do things in the same sequence,
tell the stroke survivor in advance what is
going to happen and possibly take over some
The confused or cautious stroke survivor needs
an ordered environment. The stroke survivor
with poor judgment must be guided when
making important decisions. The apathetic
stroke survivor, on the other hand, should not
live in a world so quiet and simple that there is
little to react to. The caregiver needs to be aware
of the reasons for the stroke survivor’s behavior,
without overlooking the fact that he or she may
also be depressed.
Depressions is nearly universal among people
who have had a stroke. It can be overwhelming,
affecting the spirit and confidence of everyone
involved. A depressed person may refuse or
neglect to take medications, may not be
motivated to perform exercises which will
improve mobility or may be irritable with others.
The stroke survivor’s depression may dampen the
family’s enthusiasm for helping with recovery
or drive away others who want to help. This
deprives the stroke survivor of the social contacts
which could help dispel depression, and creates a
It is possible that as time goes by and a stroke
survivor’s deficits improve, the depression may
lift by itself. Family can help by trying to
stimulate interest in other people, encouraging
leisure activities and providing opportunities
to participate in spiritual activities. If necessary,
chronic depression can be treated with individual
counseling, group therapy or antidepressant
IEED: Involuntary Emotional
Sudden language or crying for no apparent
reason and difficulty controlling emotional
responses, known as emotional lability, affects
many stroke survivors. There may be no
happiness or sadness involved, and the motional
display will end as quickly as it started.
Some stroke survivors neglect the side of their
world corresponding to the side of their brain
which was injured by the stroke. Those with leftsided
neglect do not perceive what is on their
left side. For example, the stroke survivor with
left-sided neglect may ignore the left side of the
face when washing or not eat food on the left
side of the plate. If the stroke survivor’s head is
moved to the left, neglected objects may become
apparent. If the plate is turned around, he or she
will finish eating the meal.
If a stroke causes damage to the language center
in the brain, there will be language difficulties.
Some stroke survivors are unable to understand
or speak at all. Others do not make sense when
they speak. Some can no longer read or write.
Many have difficulty pronouncing words.
Communication problems are among the most
frightening after-effects of stroke for both
the survivor and the family, often requiring
Daily Task Difficulties
Stroke survivors will find that completing simple
tasks around the house which they took for
granted before the stroke are now extremely
difficult or impossible. Many adaptive devices
and techniques have been designed especially
for stroke survivors to help them retain their
independence and function safely and easily.
The home usually can be modified so that
narrow doorways, stairs and bathtubs do not
interfere with the stroke survivor’s ability to
care for personal needs.
Helpful bathroom devices include grab bars,
a raised toilet seat, a tub bench, a hand-held
shower head, no-slip pads, a long-handled brush,
a washing mitt with pockets for soap, soap-ona-rope,
an electric toothbrush and an electric
Dressing and Grooming
Dressing oneself is a basic form of independence.
The added value of being neatly and attractively
dressed enhances a stroke survivor’s self-image.
There are many ways to eliminate the difficulties
in getting dressed. Stroke survivors should avoid
tight-fitting sleeves, armholes, pant legs and
waistlines; as well as clothes which must be put
on over the head. Clothes should fasten in front.
Velcro fasteners should replace buttons, zippers
and shoe laces. Devices which can aid in dressing
and grooming include a mirror which hangs
around the neck, a long-handled shoe horn and
a device to help pull on stockings.
Diet, Nutrition and Eating
A low-salt, low-fat, low-cholesterol diet can help
prevent a recurrent stroke. People with high
blood pressure should limit the amount of salt
they eat. Those with high cholesterol or hardening
of the arteries should avoid foods containing
high levels of saturated fats (i.e., animal fats).
People with diabetes need to follow their doctor’s
advice on diet. These diet controls can enhance
the benefits of the drugs which may have been
prescribed for control of a specific condition.
Weight control is also important. Inactive people
can easily become overweight from eating more
than a sedentary lifestyle requires. Obesity can
also make it difficult for someone with a strokerelated
disability to move around and exercise.
Some stroke survivors may have a reduced
appetite. Ill-fitting dentures or a reduced sense
of taste or smell can make food unappealing.
The stroke survivor who lives alone might even
skip meals because of the effort involved in buying
groceries and preparing food. Soft foods and
foods with stronger flavors may tempt stroke
survivors who are not eating enough. Nutrition
programs, such as Meals on Wheels, or hot
lunches offered through community centers have
been established to serve the elderly and the
Special utensils can help people with physicallyimpaired
arms and hands at the table. These
include flatware with built-up handles which
are easier to grasp, rocker knives for cutting food
with on hand and attachable rings which keep
food from being pushed off the plate accidentally.
Stroke survivors who have trouble swallowing
need to be observed while eating so that they
do not choke on their food. The same is true of
those with memory loss who may forget to chew
or to swallow. Tougher foods should be cut into
Decubitus ulcers (sometimes called “bed sores”)
can be a serious problem for stroke survivors
who spend a good deal of time in bed or who
use a wheelchair. The sores usually appear on the
elbows, buttocks or heels.
To prevent bed sores, caregivers should make
sure the stroke survivor does not sit or lie in the
same position for long periods of time. Pillows
should be used to support the impaired arm
or leg. The feet can hang over the end of the
mattress so that the heels don’t rest on the sheet,
or pillows can be put under the knees to prop
them so that the soles of the feet rest flat on the
bed. Sometimes, a piece of sheepskin placed
under the elbows, buttocks or heels can be
helpful. Special mattresses or cushions reduce
pressure and help prevent decubitus ulcers.
A stroke survivor may suffer pain for many
reasons. The weight of a paralyzed arm can cause
pain in the shoulder. Improperly-fitted braces,
slings or special shoes can cause discomfort.
Often the source of pain can be traced to nerve
damage, bed sores or an immobilized joint.
Lying or sitting in one position too long causes
the body and joints to stiffen and ache.
The quality of a couple’s sexual relationship
following a stroke differs from couple to couple.
Most couples do find that their sexual relationship
has changed, but not all find this to be
a problem. The closeness that a couple shares
before a stroke is the best indicator of how their
relationship will evolve after the stroke. It is
important to remember that sexual satisfaction,
both giving and receiving, can be accomplished
in many ways. Whatever is comfortable and
acceptable between partners is normal sexual
For the Caregiver
More than half of all caregivers in the United
States are women (59% - 75%). They face
opportunities and challenges as they work to
make quality of life better for their loves ones
who have survived a stroke.
Women who care for stroke survivors have special
• Coping with emotional / behavioral changes
• Learning to accept and address
• Accepting possible physical limitations
• Advocating for rehabilitation and other
• Dealing with changes in home environment
and day-to-day responsibilities
Caregiving can be overwhelming. There are steps
caregivers can take to make the transition from
hospital to home easier on everyone:
• Try to encourage as much independence as
• Allow your loved one to make decisions
• Support participation in leisure activities
• Try to take an occasional break from
• Ask for help from family, friends or
Stroke recovery is a life-long process filled with
achievements and setbacks. Take the good with
the challenging and embrace life with your loved
ones. Both survivors and caregivers can take
advantage of community resources to improve
their emotional well-being and overall
wellness. Get acquainted with the community
organizations in your area or refer to the back of
this guidebook for national resources for support